Provider Demographics
NPI:1912678582
Name:GARDEN OF EDEN SENIOR LIVING LLC
Entity Type:Organization
Organization Name:GARDEN OF EDEN SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-884-7598
Mailing Address - Street 1:5711 REINHOLD ST
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-2726
Mailing Address - Country:US
Mailing Address - Phone:916-884-7598
Mailing Address - Fax:916-884-7598
Practice Address - Street 1:5711 REINHOLD ST
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-2726
Practice Address - Country:US
Practice Address - Phone:916-884-7598
Practice Address - Fax:916-884-7598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility